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Arch Dis Child Fetal Neonatal Ed 2001;85:F60-F64 doi:10.1136/fn.85.1.F60
  • Original article

Foot length, an accurate predictor of nasotracheal tube length in neonates

  1. N D Embletona,
  2. S A Deshpandec,
  3. D Scottb,
  4. C Wrightb,
  5. D W A Milligana
  1. aNewcastle Neonatal Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK, bDepartment of Pathology, cRoyal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury SY3 8XQ, UK
  1. Dr Deshpandedeshpande{at}which.net
  • Accepted 26 January 2001

Abstract

BACKGROUND Existing guidelines for optimal positioning of endotracheal tubes in neonates are based on scanty data and relate to measurements that are either non-linear or poorly reproducible in sick infants. Foot length can be measured simply and rapidly and is related to a number of external body measurements.

OBJECTIVES To evaluate the relation of foot length to nasotracheal length in direct measurements at post mortem examinations, and then compare its clinical relevance with traditional weight based estimates in a randomised controlled trial.

METHODS The dimensions of the upper airway were measured at autopsy in 39 infants with median (range) postmenstrual age and birth weight of 32 (24–43) weeks and 1630 (640–3530) g. The regression equations with 95% prediction intervals were calculated to estimate the optimal nasotracheal length from foot length. In a randomised trial, 59 neonates were nasally intubated according to foot length and body weight based estimates to assess the achievement of “optimal” and “satisfactory” tube placements.

RESULTS In the direct measurements of the airway at autopsy, foot length was a better predictor of nasotracheal distances (r 2 = 0.79) than body weight, gestational age, and head circumference (r 2 = 0.67, 0.58, and 0.60 respectively). Measurement of foot length was easy and highly reproducible. In the randomised controlled trial, there were no significant differences between the foot length and body weight based estimates in the rates of optimal (44% v56%) and satisfactory (83% v 72%) endotracheal tube placements.

CONCLUSIONS Foot length is a reliable and reproducible predictor of nasotracheal tube length and is at least as accurate as the conventional weight based estimation. This method may be particularly valuable in sick unstable infants.

Footnotes

    Responses to this article

    • Suprasternal palpation-a simple method for emergency placement of endotracheal tube in neonates
      • Sanjay Patole
      Arch Dis Child - Fetal Neonatal Ed published online September 20, 2001
    • Embryological and evolutionary considerations may help identify new predictors of visceral dimension
      • EC Jesudason,
      • "PD Losty, DA Lloyd"
      Arch Dis Child - Fetal Neonatal Ed published online September 13, 2001
    • Foot length and neonatal intubation
      • Stephen W Hancock,
      • "Taj Ahmed, David Gibson"
      Arch Dis Child - Fetal Neonatal Ed published online July 27, 2001

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